Northern Arapaho Tribe Sues Drug Companies Over Opioid Epidemic

The Northern Arapaho Tribe has sued six pharmaceutical companies and three drug distributors that do business in Wyoming for the harm done to tribal members by the opioid crisis, according to a lawsuit filed in federal court on Monday.

"The Tribe has seen child welfare and foster care costs associated with opioid-addicted parents skyrocket, their health services have been overwhelmed, education and addiction therapy costs have substantially increased, and almost every tribal member has been affected," according to the 109-page compliant filed by the Tribe's attorneys.

The Tribe wants a jury trial to recover from the drug companies actual and consequential damages; their revenues and profits from opioid distribution; past and future expenses caused by the epidemic; compensatory damages for treating addicted patients and infants born with opioid-related medical conditions; costs for care of children whose parents suffer from opioid-related disabilities; costs for public safety; and other damages.

The Tribe is suing the defendants under laws about public nuisance; the Racketeer-Influenced and Corrupt Organizations Act; the Lanham Act that forbids using false or misleading information about a good or service; deceptive trade practices; fraud; negligence and gross negligence; negligence per se by misrepresenting the risks and benefits of their products; unjust enrichment; and civil conspiracy.

The manufacturing defendants are:

Purdue Pharma, which makes and sells opioids such as OxyContin and Dilaudid. OxyContin is Purdue's best-selling opioid, with annual sales ranging between $2.47 billion and $2.99 billion since 2009.

Cephalon makes and sells Actiq and Fentora.

Janssen makes and sells fentanyl, an opioid 80 to 100 times more powerful than morphine.

Endo Health Solutions develops, markets and sells Opana, Percodan, Percocet and Zydone, as well as generic opioids including oxycodone, oxymorphone, hydromorphone an hydrocodone.

Other tribes have sued opioid manufacturers and distributors. In January, three tribes in South Dakota sued many of the same defendants.

On March 5, three tribes filed a similar lawsuit in federal court in Tacoma, Wash.

In response to the three tribes' lawsuit in Washington state, Purdue Pharma denied the allegations. A company spokesman told the Kitsap Sun in Bremerton, Wash., "We are deeply troubled by the prescription and illicit opioid abuse crisis, and we are dedicated to being part of the solution. As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge.”

The Northern Arapaho Tribe's lawsuit also named the top three distributors of prescription opioids: AmerisourceBergen, Cardinal Health and McKesson.

The lawsuit outlines the modern history of the use of opioids. Before 1990, medical practice standards dictated opioids only should be used for acute pain, post-surgical pain, or end-of-life care. Doctors generally did not prescribe opioids for chronic pain because of the risks of addiction.

But pharmaceutical companies needed to change this if they wanted larger and more lucrative markets, so they persuaded doctors to unwittingly prescribe huge amounts of opioids, according to the lawsuit. "Defendants also intentionally neglected their obligations to prevent diversion of the highly addictive substance."

In 2016, the national average rate of dispensed opioid prescriptions was 66.5 per 100 persons. In Wyoming, the average was 71.1 per 100. In Fremont and Hot Springs counties, where tribal members live, the rates were 83.3 per 100 and 98.1 per 100 respectively.

The effects on American Indian communities nationwide are disproportionate, according to the lawsuit. The U.S. Centers for Disease Control reported in 2012 that one in 10 American Indians over 12 used prescription pain medicine for nonprescription purposes, compared to one in 20 whites and one in 30 African Americans.

Drug overdose deaths among all Americans increased more than 200 percent between 1999 and 2015, but they increased 500 percent among American Indians and native Alaskans during the same time.

Meanwhile, use and death rates from heroin -- often used when opioids are not available -- for whites and American Indians has also skyrocketed.

The Northern Arapaho Tribe asserts opioid manufactures and distributors have spent millions of dollars "on promotional activities and materials that falsely deny or minimize the risks of opioids while overstating the benefit of using them for chronic pain."

The defendants have downplayed the seriousness of addiction, exaggerated the effectiveness of screening tools to prevent addiction, claimed opioid dependence and withdrawal are easily managed, and denied risks of higher dosages, among other actions, according to the lawsuit.

To further their business, they created third-party front groups to promote the use of opioids and to oppose critical articles and potential regulations.

The companies also fostered an illicit market for opioids by allowing drugs to be transferred from a legitimate distribution channel or use to illegitimate ones.

The disruption in the supply chain included distributors not monitoring doctors who bought large quantities of commonly abused opioids; drugs lost or stolen in transit; pharmacists filling prescriptions without questioning their medical purpose; people traveling long distances to fill prescriptions; and forging prescriptions.

These practices directly affected the Northern Arapaho Tribe.

"The Distributor Defendants knew or should have known that the opioids being diverted from their supply chains would contribute to the opioid epidemic faced by the Tribe, and would create access to opioids by unauthorized users, which, in turn, perpetuates the cycle of addiction, demand, illegal transactions, economic ruin, and human tragedy."

While not mentioned in the lawsuit, some customers of former Casper Dr. Shakeel Kahn would obtain prescriptions for opioids -- bought for $500 in cash at his office -- and distribute them in the Wind River Reservation. (Kahn is in custody awaiting trial in federal court on multiple counts related to distribution of opioids.)

But the lawsuit does state that about 60 percent of the opioids that are abused in the Tribe come directly or indirectly through doctors' prescriptions.

The consequences are wide and deep, according to the lawsuit:

"Many patients who become addicted to opioids will lose their jobs. Some will lose their homes and their families. Some will get treatment and fewer will successfully complete it; many of those patients will relapse, return to opioids or some other drug. Of those who continue to take opioids, some will overdose -- same fatally, some not. Others will die prematurely from related causes -- falling or getting into traffic accidents due to opioid-induced somnolence; dying in their sleep from opioid-induced respiratory depression; suffering assaults while engaging in illicit drug transactions; or dying from opioid-induced heart or neurological disease. The opioid epidemic undermines the ability of the Tribe to self-govern and to maintain and develop economic independence."